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Obamacare Marketplace Profile: Federal-State Partnership Exchanges

Obamacare Marketplace Profile: Federal-State Partnership Exchanges

Posted Sep 30, 2013 by Jenifer Dorsey

The Affordable Care Act gave U.S. states three health insurance marketplace options: default to a federally facilitated exchange, build a state-based exchange, or create a state-federal partnership. Seven opted for a partnership situation. If your state is among them, or even if it isn’t, you may wonder what this means. In this type of exchange, the state retains responsibility for managing some customer service and/or operational functions and hands others over to the federal government.

Federal-state partnership exchanges are as follows:

  1. Arkansas
  2. Delaware
  3. Illinois
  4. Iowa
  5. Michigan
  6. New Hampshire
  7. West Virginia

Illinois and Iowa intend to transition to state-based plans by 2015, according to the Kaiser Family Foundation’s State Exchange Profiles. At this time, the others have not indicated plans to operate independently.

Partnership marketplace websites: While some of the states listed above have informational websites, consumers will ultimately shop for and enroll in coverage at healthcare.gov.

Informational sites, for the four states that have them, are as follows:

Plans: Plan details for partnership states will become available at healthcare.gov on Oct. 1, 2013, when all health insurance exchanges begin open enrollment for 2014 coverage. Coverage at healthcare.gov, as with all qualified health plans, falls into Obamacare’s four metal level categories —bronze, silver, gold and platinum. A catastrophic plan for those younger than 30 and others who qualify due to income will also be available.

These plans will also include services within the 10 essential health benefits categories. In states that did not select a benchmark plan for essential health benefits, the default EHB plan became the state’s largest small group health plan.

Rates: Consumers will have access exchange-based health insurance rates starting Oct. 1. Monthly premiums will vary based on plan selectionas well as the applicant’s age, geographical location, family size and tobacco use. Under the Affordable Care Act, Americans cannot be denied coverage or charged more due to preexisting conditions. These provisions apply whether plans are purchased via the marketplace or not.

Those who purchase health coverage through state-based and federally operated exchanges, including partnership situations, may qualify for tax credits and additional premium subsidies, depending on household income. The healthedeals.com Health Care Reform Calculator, which was listed among The Financial Times “Best Online Tools for the Toughest Health Questions,” can help those planning to buy from an exchange calculate their Obamacare health insurance cost and tax credit.

Consumer assistance: Need help understanding how health insurance works, selecting a plan or applying for coverage? No matter what type of exchange your state offers, you can use healthcare.gov’s Find Local Help search to find resources near you. Enter your city, state or ZIP code to get personal, local assistance with selecting and applying for the right health insurance plan.

Considering your overall health and financial needs

When shopping for health insurance, it is important to look at the big picture. Consider your family’s overall health care expenses and needs in a year. Are there any ongoing medical needs or prescription drugs? Do you foresee any additional medical expenses in the upcoming year?

When planning for 2014, consider additional coverage such as dental insurance, critical illness insurance, and/or a bundled gap plan that includes benefits such as accident medical expense insurance and accident disability income insurance. Supplemental insurance is not available through state-based or federally operated health insurance exchanges; however, this coverage easy to obtain directly from the plan’s carrier or a licensed agent or broker.

Need coverage now? 

If you need health insurance to get you by until January 1, 2014, a temporary insurance plan can provide coverage for as few as 30 days. Start shopping on healthedeals.com or contact a healthedeals.com sales consultant for more information on short-term health insurance and supplemental plans.

Jenifer Dorsey is a freelance writer whose specialties include health and fitness, wellness, sports and recreation. She is a competitive amateur track cyclist who also enjoys mountain biking, hiking, camping and other outdoor adventure. Jenifer received a B.A. in journalism from Columbia College Chicago and is an MFA candidate at Naropa University. She lives in Colorado.